Multi-functional double bladed surgical tool

ABSTRACT

An apparatus for creating minimal skin incisions and soft tissue tunnels, particularly useful in the insertion of transverse or oblique screws through a bone and the holes in a locking nail embedded within the intra-medullary cavity of the bone. A unique surgical tool, as described herein, is used in conjunction with a targeting guide and targeting guide tunnel to create skin and soft-tissue tunnels that are precise, of minimal size, and minimally traumatic for the patient, and very quick and easy for the surgeon to create and to repair.

This patent application claims priority to Patent Application Ser. No.61/572,160 filed on Jul. 11, 2011.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to the field of orthopedic surgery and inparticular to making incisions in the skin and soft tissues to godirectly to the surface of a fractured bone to affix locking screws intothe bone. The present invention further relates to the use of a lockingnail and guide means to reach to the surface of the bone so that aproper incision can be made to enable a locking screw to be affixed intothe bone and the embedded locking nail with a minimum of surgicalcutting and blood loss. The present invention also relates to the fieldof scalpels used to make the required incision so that a locking screwcan be affixed into the bone with a minimum of surgical cutting andblood loss.

2. Description of the Prior Art

The fairly recent development of intra-medullary locking nails has beena significant breakthrough in the surgical management of fractures ofthe long bones in humans and animals.

Locking nails provide superior fixation to that provided by on-layplates secured by screws. Equally significantly, they can be installedin the bone with far less surgical injury to the patient. The skinincisions are smaller. The soft-tissue trauma is less. The amount ofblood-loss is much less. The overall recovery from surgery is speedierand more pain-free. The impact of locking nails on the surgicalmanagement of long-bone fractures cannot be overstated.

The installation of a locking nail, which is a long metal rod and willbe interchangeably referred to as a rod or a nail, is accomplished byinserting it, through a small skin incision, into one end of the bone,and advancing it into the bone cavity (medullary cavity) so that the rodis embedded within that cavity. This metal rod has preformed holes atintervals along its length for receiving screws that are insertedtransversely or obliquely through the shaft of the bone. In this way thetraversing screws lock the bone fragments to the embedded rod, orconversely, lock the rod to the bone. Each traversing screw is insertedinto the bone through a small skin incision, and herein lays theproblem.

For the placement of each traversing screw, the technical problems forthe surgeon include, firstly, making the small skin incision at thecorrect location and correct angle on the skin surface, and extendingthe incision through the skin and soft-tissues, down to the bonesurface. Instruments are now passed through this small skin andsoft-tissue path, to drill a hole that passes through one side of thebone, through the unseen hole in the rod, and into the bone on the farside of the rod.

The challenge of finding the exact spot on the bone's outer surface todrill the first hole, and then to drill in precisely the right directionfor the drill bit to pass centrally through the hole in the rod, hasbeen ingeniously solved by the use of a targeting guide. The targetingguide is attached to an outrigger that is rigidly, and removably,attached to one end of the rod. When the nail is embedded in the bone,this attached outrigger and targeting guide protrude from the insertionwound, and lie outside the body. Note that in some device brands, theoutrigger and targeting device are a single part. The targeting guidelies parallel with the embedded nail. Within the targeting guide, alongits shaft, are tunnels (the targeting guide tunnels) that line upprecisely with the holes in the embedded, and unseen, rod. In placing ascrew through the bone and the hole in the embedded rod, variousinstruments are passed through the matching targeting guide tunnel inthe targeting guide. Drill bits are long and narrow and sometimesbrittle, and their rotating motion can damage soft-tissues. For thisreason they are supported and guided, and the tissues are protected fromthem, by passing them through a metal sheath, the drill-guide. There isno standard nomenclature in the industry for the terms “outrigger”,“targeting guide” and “targeting guide tunnel”, but the usage of theseterms in this patent application can leave no doubt as to the meaning ofthese terms as used here.

The drill guide is a metal tube that has an outer diameter such that itsnugly passes through the matching targeting guide tunnel. The innerdiameter of the drill guide is such that the drill bit snugly passesthrough it. Its leading edge cones down to a bullet-nose.

As a first step for inserting a screw through the wall of the bone andinto the underlying rod-hole, the drill-guide is inserted into thematching targeting guide tunnel. The drill guide is advanced to theskin. A mark is made at the site of skin contact. The drill guide iswithdrawn, and an incision is made through the skin and soft-tissuesuntil the scalpel blade reaches the bone.

The drill guide is now advanced through this skin incision andsoft-tissue path, until its advancing end comes into contact with thebone. The drill-guide, thus placed, is now perfectly located to guide adrill bit to the correct site on the surface of the bone, at preciselythe correct angle, to drill through the bone and through the hole in therod. The drill bit is then advanced deeper into the bone, or out throughthe opposite cortex (wall) of the bone. Once a hole has been drilledthrough the bone and the hole in the rod, the drill guide is removedfrom the targeting guide tunnel and a screw guide sleeve is insertedinto the targeting guide tunnel. The screw guide sleeve is used to guidethe screw and the screwdriver to the nearside hole in the bone, andthrough it to the hole in the nail, and out through the hole into thebone on the other side of the nail.

The current practice for cutting the skin incision and a path throughthe soft-tissues down to the bone is crude and imprecise. The currentpractice starts wherein the skin entry-site is located by advancing thedrill guide through its targeting guide tunnel until it touches theskin. A mark then is made on the skin at the contact site. The drillguide is partly withdrawn away from the skin but is left in thetargeting guide tunnel. The surgeon then makes a free-hand skin incisionat the marked skin site, using a regular, standard, single-bladedscalpel. The bulky targeting guide blocks direct access to the skin andthe surgeon has to work around it. The only direct access to the markedskin site would be though a targeting guide tunnel. As things currentlystand, the scalpel is now directed in front of or behind the targetingguide, angled obliquely through the skin incision and soft-tissues, atan approximately anticipated compensating angle, to a mentallycalculated and imprecise location on the bone surface. Because this isnot the best angle for the incision, the surgeon makes an oversized,irregular skin cut and soft-tissue path that is not at an ideal angle.

For the scalpel to make the skin incision and soft-tissue path at thecorrect angle and with the shortest path from the skin to the bone wouldrequire that the scalpel pass directly though the targeting guidetunnel. Since the targeting guide tunnel guides the drill guide to theprecise location on the bone for drilling the hole into the bone, thesame tunnel could usefully serve to accurately guide a scalpel throughthe skin and soft-tissues to the same, precise target point on the bone.

One problem with this solution is that commercially available scalpelsdo not have handles that are long enough to pass through the targetingguide tunnel and cover the distance down to the bone. If the a scalpelhad a longer handle, the surgeon could make a straight pass with theblade, directly through the targeting guide tunnel, through the skin andsoft tissues, and down to the bone.

The above solution by itself is not presently viable because an incisionmade through the targeting guide tunnel with the currently availablefixed-blade scalpels would be too small to accommodate the drill guideor the screw driver sleeve. This is because the widest blade that couldpass through the targeting guide tunnel would have a width equal to theinternal diameter of the targeting guide tunnel. However, a skinincision whose length equals the internal diameter of the targetingguide tunnel would be insufficient to allow passage of a cylindricalinstrument (such as the drill guide) that has an external diameter thatequals the internal diameter the targeting guide tunnel. If the skin hadno elasticity, the length of the smallest skin incision that will allowpassage of the drill guide can be calculated; it is equal to half thecircumference of the drill guide. The circumference (C) of thecylindrical drill guide is calculated as π multiplied by the diameter(D) of the drill guide (C=πD). Thus, if the diameter of drill guide were10 mm, the circumference of the drill guide would be 3.14 multiplied by10 mm, which equals a circumference of 31.4 mm. In non-elastic skin thelength (L₁) of the smallest skin incision that would accommodate thedrill guide would therefore be half the circumference (C) of the drillguide. L₁=πD×0.5. Thus, in non-elastic skin, a skin incision 15.7 mmlong is needed for a 10 mm cylindrical drill guide to pass through it:i.e. an incision that is 57% longer than the diameter of the cylindricaldrill guide. It can be seen that at present, the widest scalpel bladethat could pass through a 10 mm diameter targeting guide tunnel, cannotbe 15.7 mm wide, but instead only 10 mm wide, and further, that a 10 mmrigidly guided scalpel blade cannot make an incision that is greaterthan 10 mm wide, such as the 15.7 mm that is needed in the presentexample, if the scalpel cuts only in a thrusting mode, with no side toside slicing motion. This percentage is constant: in non-elastic skin,the incision needed for passage of a cylindrical instrument will need tobe 57% longer than the diameter of that instrument for all sizes ofinstrument.

Human skin does have elasticity, and normally, an incision in human skinwill stretch 25% to 30%. This is still less than the 57% needed for acylindrical instrument to pass through a skin incision that equals inlength the diameter of that cylindrical instrument.

Therefore, even allowing for the elasticity of normal human skin, thewidest, fixed-blade scalpel blade that could be passed through any sizetargeting guide tunnel could not make a skin incision adequate for thepassage of the corresponding drill guide.

Given the elasticity of human skin, the present invention scalpelinstruments can make an incision that is less than the 57% enlargement,and still be adequate.

Assuming a skin stretch of 25%, a 12.6 mm incision will stretch to 15.75mm, which is sufficient for the passage of a 10 mm cylindricalinstrument. This is 2.6 mm (26%) greater than the drill guide diameterof 10 mm.

In summary, assuming a skin incision that will stretch 25%, the incisionwill need to be 26% longer than the diameter of any cylindricalinstrument, to enable the said instrument to pass through that incision.

Locking screws placed through the lateral aspect of the proximal femurhave to pass through a tough, inelastic fascial layer, called the fascialata. The fascia lata poses a special problem over the proximal femur inlocking nail fracture fixation. The iliotibial band is not quite asthick or tough as the fascia lata, but it poses a similar problem overthe lateral aspect of the distal femur. The term “deep fascia” will beused to describe either. The deep fascia forms a barrier to the passageof the drill guide and other instruments. It lies against the bone atthe deepest part of the narrow soft tissue incision tunnel. A pointedknife thrust straight into it will only make a small puncture hole.Slicing motion is required to adequately enlarge the puncture hole forpassage of the instruments. It is impossible to enlarge the puncturehole without enlarging the soft tissue tunnel as well, thereby causingadditional soft tissue damage.

In current practice, the surgeon passes the scalpel anterior orposterior to the targeting guide and through the skin and soft tissues,to blindly slice the deep fascia. Made in this oblique fashion, thefascial incision does not line up perfectly with a straight line betweenthe targeting guide tunnel and the target point on the bone surface. Thesurgeon therefore makes long sweeping motions with the tip of the knife,making an unnecessarily oversized fascial incision. The fascial incisioncannot be repaired later, since it lies in the depth of a narrowsoft-tissue tunnel. The fascia lata connects to the iliotibial band.Both play a vital role in normal gait. Excessive damage to the fascialata or iliotibial Band may later result in impaired gait.

There are many “perforating” arteries just deep to the fascia lata. Thelarger the fascial incision the more blood vessels will be cut, causingproportionately increased bleeding.

A tunnel-guided-knife as described herein will predictably make thesmallest possible skin and soft tissue incision. However, asharp-pointed blade plunged through the skin straight down to the bone,and then withdrawn back along the identical path, guided in and out bythe rigid targeting guide tunnel, will have a terminal configurationthat strictly matches the profile of the blade.

Any blade, other than a chisel-shaped blade, will always have asharp-pointed leading edge, which will cause the terminal end of thetunnel to be triangular. A chisel-blade is impractical since it will notpenetrate the skin. A triangular end-tunnel will be of no consequencewhere the entire tunnel is through soft tissues, such as fat and muscle.However, the deep facia along the lateral thigh is a tough barrier thatlies adjacent to the bone.

Any in-and-out blade, other than a chisel, will penetrate the deepfascia with an incision that is always less than the full width of theblade, and likely to be little more than a puncture point. Enlarging thedeep fascial incision with a pointed blade would require side-to-sideslicing motion, which is not possible with a fixed blade, attached to arigid cylindrical handle, which is guided by a rigid targeting guidetunnel. Making a minimal incision in the deep fascia at the terminal endof a minimal skin and soft tissue tunnel thus represents a specialchallenge in using a tunnel-guided knife.

For the sake of speed and convenience, given the technical problems ofblindly passing a scalpel anterior or posterior to the targeting guide,surgeons frequently make an initial skin incision, soft-tissue path andfascial incision that is much larger than the minimum needed to get thejob done. Alternatively, the surgeon may start with a small, tentativeskin incision and enlarge it when he/she finds that it is too small forthe drill guide to pass through. This free hand, secondary enlargementwill often result in a jagged incision, and the subsequent healed scarwill be jagged and cosmetically unsatisfactory.

Additionally, skin incisions and soft-tissue tunnels must be made foreach screw, and there is at least one and generally multiple screws thatmust be applied. At the end of the operation the surgeon has to closeeach of the individual skin wounds, a process which can betime-consuming, the total time being directly related to the length ofeach incision.

In the operation of locking nail fracture fixation, there are compellingreasons for the locking-screw incisions through the skin, soft tissuesand deep fascia to be as small as possible. The smallest incisions canonly be made through the targeting guide tunnel. Ideally each incisionneeds to be just large enough to accommodate the outer diameter of thedrill guide. Skin and soft tissue incisions made through the targetingguide tunnel with a fixed-blade scalpel are too small. A pointed knifethrust straight into the deep fascia through the targeting guide tunnelwill only make a small puncture hole, and slicing motion is required foran adequate incision.

SUMMARY OF THE INVENTION

The present invention is a multi-functional double bladed surgical tool.The present invention resolves all the problems discussed above. Thepresent invention is a method and a surgical instrument for predictablyand efficiently making the skin incision, soft-tissue path and deepfascial incision, with the smallest, least damaging, and most preciseincision. The present invention makes the quickest, cleanest, mostprecise incision from the skin to the bone than has been seen in theprior art. Additionally, the resulting incision will be much lesstraumatic than can be made free hand, with a conventional scalpel. Itwill also enable the surgeon to make the incision quicker and easier,complete the surgery quicker and easier, and allow the patient to healwith less scarring and with less likelihood of, and reduction of adversesecondary effects.

The present invention also relates to a method and apparatus forefficiently making a skin incision and a soft-tissue path from the skinto the bone. The invention herein relates more specifically to asurgical method and a surgical instrument, heretofore unseen in theprior art, for making a skin incision and soft-tissue path from the skinto the bone, and for making the smallest, least damaging, most preciseskin incision and soft-tissue path to the bone, and doing so in a mannerthat is quicker and easier for the surgeon and resulting in the overalloperation being quicker and easier for the surgeon, and the patientexperiencing less trauma, less scarring, greater healing and lesslikelihood of damaging or adverse side effects.

Described herein is a method and novel instrument for making an incisionof precise and minimal dimensions, in a precise and exact direction,having the shortest path from the skin to the bone. The result is thesmallest skin and soft-tissue incision possible, made speedily andaccurately. It will be seen that this additionally results in the leastamount of tissue trauma possible, shortened operating and anesthesiatime, and less blood loss. Further, the incision is easier to repair,and heals with a cosmetically superior scar.

Additionally described herein, is a technique and instrument for makinga skin and soft-tissue incision utilizing the targeting guide. Since thetargeting guide tunnel guides the drill guide to the precise location onthe bone for drilling the hole into the bone, the same targeting guidetunnel can usefully serve as the perfect targeting device for guiding ascalpel through the skin and soft-tissues to the same target point onthe bone. In order to do so, the scalpel handle will need to be acylinder. Conventionally, scalpel handles are flat in order to give thesurgeon maximum, ergonomic, manual control over the direction androtation of the cut. However, a scalpel with a cylindrical handle havinga diameter that is the same as that of the targeting guide tunnelthrough which it is being passed will be provided maximum directionalcontrol by the targeting guide tunnel. The surgeon's wet, gloved handmay still have difficulty with rotational control over the smoothcylindrical handle, and therefore the blade. This can be overcome byflattening opposite surfaces of the cylindrical handle so that thehandle becomes a partial cylinder. Thus, regardless of the shape of thehandle, so long as its perimeter fits snugly within the inner diameterof the targeting guide tunnel, the goals and advantages of the presentinvention will be achieved.

The present invention further overcomes the problem that presentlyavailable conventional scalpels are six to eight inches long, which isinsufficient to achieve the objectives of the present invention. Thebarrel of the present invention scalpel instrument will be longer topass through the targeting guide down to bone, and still leavesufficient handle protruding for the surgeon to grasp.

The present invention further overcomes the problems with the prior artscalpels by creating a scalpel instrument that is capable of achievingthe objectives of the invention. The present invention apparatus is anovel scalpel instrument that can be passed through the targeting guidetunnel to accurately make a most minimal but adequate incision toaccommodate the drill guide and other instruments.

In a first embodiment, two or more blades are employed to form thecutting edge. The present invention teaches a means for radiallynarrowing the cutting edge of the blades of the scalpel instrument forinward passage through the targeting guide tunnel, a means for radiallyrestoring the blades and their cutting edge to its full width afterpassage through the targeting guide tunnel in preparation for making anadequate skin incision, and a means for radially narrowing the bladesand their cutting edge for withdrawal of the scalpel through thetargeting guide tunnel after the incision has been made.

The present invention also teaches a means for accurately andpredictably making a most minimal but adequate, incision in the deepfascia, at the exact and precise location that it is needed, by means ofthe two blades functioning together as a surgical scissors apparatus, orviewed alternately as two blades each independently making slicingincisions in the deep fascia. The present invention teaches a means formaking the blades of a single instrument function interchangeably as asurgical scalpel and a surgical scissors. The present invention teachesthe method of making a cruciate incision in the deep fascia as being themost minimal, least damaging incision possible

In a second embodiment, the present invention teaches a means forcreating an adequate incision using a single-blade scalpel, wherein theblade rotates for deployment.

The innovative and novel scalpel instruments of the present inventionmay be made available with barrel handles of different diameters. Thesurgeon selects a scalpel of suitable barrel diameter to match thetargeting guide tunnel of the manufacturer-specific locking nail devicein use. For each scalpel barrel diameter, the cutting edges will makeadequate skin and fascial incisions to accommodate passage ofinstruments of matching diameter, through the resulting skin and deepfascial incisions. The present invention scalpel could be used with theinstrumentation of any locking nail manufacturer, as long as the correctscalpel barrel diameter is selected to fit that targeting guide tunnel.

The cutting edge of the first embodiment of the present inventionscalpel instrument contracts radially for inward passage through thetargeting guide tunnel, then expands radially for making the incision,and again contracts radially for the exit passage through the targetingguide tunnel. The mechanism for causing the cutting edge of the scalpelto expand or contract radially is immaterial to the apparatus, method,technique, objectives, and principles described in this patent. It iswithin the scope of the present invention that the mechanism for causingthe cutting edge of the scalpel to expand or contract radially couldutilize alternative methods, or use one or more blades to achieve thesame desired result.

In the preferred embodiment and method, two or more blades are mountedwithin the scalpel barrel, near the leading edge of the scalpel. In thecontracted position of the blades, the cutting edge does not protruderadially beyond the profile of the scalpel barrel. A mechanism actuatedby the surgeon causes the blades to protrude radially from the handlewhen needed. The blades are configured in such a way that, in theradially protruded position, they act together, as a single cutting edgethat is wider than the scalpel barrel. The two blades are alsoconfigured so that in moving from the contracted to the protrudedposition and back again the blades function together as a surgicalscissors. A single instrument thus functions interchangeably as ascalpel and a surgical scissors.

The present invention method and scalpel instrument is discussed herefor illustrative purposes as used in orthopedic surgery. Thisdescription in no way implies that the use of the knife, or thetechnique, is limited to orthopedic surgery, limited to fracturesurgery, limited to surgery on bone, or limited to surgery on humans.

Further novel features and other objects of the present invention willbecome apparent from the following drawings, detailed description anddiscussion.

BRIEF DESCRIPTION OF THE DRAWINGS

Referring particularly to the drawings for the purpose of illustrationonly and not limitation, there is illustrated:

FIG. 1 is a plan view of a preferred embodiment of the present inventionscalpel instrument illustrating the position wherein the two blades areradially expanded and in a convex V-shape configuration;

FIG. 2 is a plan view of a preferred embodiment of the present inventionscalpel instrument illustrating the position wherein the two blades areradially retracted and in the concave V-shape or open-scissors position;

FIG. 3 is a detail of a preferred embodiment of the present inventionscalpel instrument with the cutting edges of the two blades in theconcave V-shape or open scissors formation, the illustration in apartially open condition to show the actuation mechanism;

FIG. 3A is a detail of a preferred embodiment of the present inventionscalpel instrument with the cutting edges of the two blades illustratedin a convex V-shape radially expanded condition not illustrating theinternal actuation mechanism as in FIG. 3;

FIG. 3B is a detail of the two blades of the preferred embodiment of thepresent invention scalpel separated so that the angular slots in eachblade are visible;

FIG. 3C is a detail of the two blades of the preferred embodiment of thepresent invention scalpel illustrated with one blade crossing over theother blade during a portion of a scissors-action cycle;

FIG. 4 is a detail of a preferred embodiment of the present inventionscalpel instrument illustrating a preferred means of radially expandingthe two blades, and the position of the cutting edges of the two bladesin the convex V-shape radially expanded, formation, the illustration ina partially open condition to illustrate the actuation mechanism;

FIG. 4A is a detail of a preferred embodiment of the present inventionscalpel instrument illustrating the position of the cutting edges of thetwo blades in the concave V-shape or open scissors formation, theillustration shown in a totally closed condition and not illustratingthe interior actuation mechanism as in FIG. 4;

FIG. 5 is an exploded view of the insertion device of the locking nail,including a locking nail, a targeting device, and an outrigger;

FIG. 6 is a perspective view of a locking nail, a targeting device andan outrigger, joined together, illustrating the relationship of thethree to each other;

FIG. 7 is an illustration, not to scale, of a partial cross-section of abone covered with skin and soft tissues with the locking nail insertedinto the bone and a perspective view of the aligned targeting guide inplace with the present invention scalpel instrument inserted through atargeting guide and the deployed blades moved out of the scalpel andpresented to and about to penetrate the skin and soft tissues with thescalpel blades in a convex V-shape formation;

FIG. 8 is a detail illustration of prior art and the presentation ofprior art scalpel advanced through the skin and soft-tissue to a bone;

FIG. 9 is a detail illustration of prior art and the inadequacies of theincision and soft-tissue tunnel to the bone;

FIG. 10 is a detail illustration, not to scale, the next step after FIG.7, wherein there is illustrated a cross-sectional view of the preferredembodiment of the present invention scalpel instrument in use in themethod of the present invention, wherein the blades of the scalpelinstrument are in the convex V-shape formation and have advanced throughthe skin and soft-tissue, penetrated the deep fascia, and have reachedthe bone;

FIG. 11 is a detail illustration, not to scale, of the next step afterFIG. 10 wherein there is illustrated a cross-sectional view of thepreferred embodiment of the present invention scalpel instrument in usein the method of the present invention, wherein the blades of thescalpel instrument are in the convex V-shape formation, and havingreached the bone in FIG. 10, and are now being withdrawn; Alsoillustrating that a soft-tissue tunnel has been made in the skin andsoft tissues from the previous steps; the terminal end of the tunnel isconvex V-shaped, the deep fascia has been penetrated by the sharp tip ofthe scalpel;

FIG. 12 is an illustration, not to scale, of the next step after FIG. 11wherein there is illustrated a partial cross-section of a bone coveredwith skin and soft tissues with the locking nail inserted into the boneand a perspective view of the aligned targeting guide in place with thepresent invention scalpel instrument inserted through a targeting guidetunnel and the blades in the retracted concave V-shape open-scissorsposition, also illustrating that a convex V-shape soft-tissue tunnel hasbeen made from the previous steps;

FIG. 13 is an illustration of the preferred embodiment of the presentinvention scalpel instrument in use in the method of the presentinvention, wherein the blades of the scalpel instrument are in theconcave V-shape open-scissors formation, and the scalpel instrument hastraversed the wider soft-tissue tunnel path created by the presentinvention scalpel when it was in the convex V-shape formation, and hasnow reached the bone; the two sharp tips of the blades have penetratedthe deep fascia and have come to rest against the bone; the incision inthe deep fascia has a length equal to the diameter of the drill guide,and not the width of the deployed scalpel blades, and is smaller thanthe skin and soft-tissue tunnel;

FIG. 14 is a detail illustration, not to scale, of the next step afterFIG. 13, of the preferred embodiment of the present invention scalpelinstrument in use in the method of the present invention, wherein theblades of the scalpel instrument are in the concave V-shapeopen-scissors formation, and the scalpel instrument is being withdrawn;the first arm of the cruciate incision has been made by a scissoringaction of the present invention scalpel invention, the incision in thedeep fascia is narrower than the width of the skin and soft-tissuetunnel;

FIG. 14A is a detail illustration, not to scale, of the first step inmaking a cruciate incision in the deep fascia, the two blades of thepresent invention scalpel instrument have punctured the deep fascia inthe concave V-shape position;

FIG. 14B is a detail illustration, not to scale, of the incision in thedeep fascia after the present invention scalpel instrument has puncturedthe deep fascia in the concave V-shape position with the two bladeshaving moved toward each other in a scissors-action and have completedthe first arm of the cruciate incision in the deep fascia;

FIG. 14C is a detail illustration, not to scale, of completing thecruciate incision in the deep fascia after the present invention scalpelinstrument has punctured the deep fascia in the concave V-shape positionand by scissors-action having completed one arm of the cruciate incisionin the deep fascia, the scalpel instrument then partly withdrawn androtated 90 degrees and then advanced toward the bone to penetrate thedeep fascia a second time in the concave V-shape position;

FIG. 14D is a detail illustration, not to scale, of the next step in themethod, illustrating the preferred embodiment of the present inventionscalpel instrument being withdrawn from the cruciate incision, aftercompleting the second arm of the cruciate incision by a scissors action,thus making a cruciate incision in the deep fascia with two equal arms,an incision large enough to allow passage of the bullet-nosed leadingend of the drill guide to pass through the deep fascia and down to thesurface of the bone as seen in FIGS. 14E and 14F, thereby allowing fullaccess to the bone and the future placement of a screw unimpeded andwithout further damage to the soft-tissue, through the most minimalincision that could be made to accommodate the bullet nose of the drillguide;

FIG. 14E is a detail illustration not to scale, illustrating thebullet-nosed drill guide having passed through the targeting guidetunnel, having passed through the soft tissue tunnel in the skin andsoft tissues and about to pass through the cruciate incision in the deepfascia;

FIG. 14F is the next step in the method, illustrating the bullet-noseddrill guide having passed through the cruciate incision in the deepfascia and against the bone, in readiness for the drill to pass throughthe drill guide and drill a hole through the bone for placement of ascrew into the bone;

FIG. 15 is an illustration, not to scale, of a partial cross-section ofa bone covered with skin and soft tissues with the locking nail insertedinto the bone and a perspective view of the aligned targeting guide inplace with the present invention scalpel instrument inserted through atargeting guide tunnel in the step after FIG. 14 and scalpel instrumentremoved from the skin and soft-tissue, and leaving a perfectly alignedtunnel in the skin and soft tissues;

FIG. 16 is an illustration, not to scale, of a partial cross-section ofa bone covered with skin and soft tissues with the locking nail insertedinto the bone and a perspective view of the aligned targeting guide inplace with the screw guide sleeve inserted through the opening in theskin and soft tissues left by the present invention and a screw driverinserting an affixing screw which passes through an opening in thelocking nail within the bone; and

FIG. 17 is an illustration of the bone after the use of the method andapparatus of the present invention has been utilized and two screws areproperly and precisely affixed at the correct angles to the bone, andthrough holes in the locking nail.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Although specific embodiments of the present invention will now bedescribed with reference to the drawings, it should be understood thatsuch embodiments are by way of example only and merely illustrative ofbut a small number of the many possible specific embodiments which canrepresent applications of the principles of the present invention.Various changes and modifications obvious to one skilled in the art towhich the present invention pertains are deemed to be within the spirit,scope and contemplation of the present invention.

In FIGS. 1 and 2, there is shown a preferred embodiment of the presentinvention scalpel instrument 10. The scalpel instrument 10 preferablyhas two blades 20 and 30, but may have one or more. The scalpelinstrument 10 has a long barrel 40, having a length L1″ that is longenough to traverse the length of a targeting guide tunnel and furtherextend through the skin and soft-tissue of a patient to the patient'sbone. It has been found that the preferable length L1″ of the barrel 40is nine and a half inches to meet most current requirements, however thelength of the barrel 40 may be whatever length is surgically required.The diameter D1 of the barrel 40 is preferably the same as the innerdiameter of the targeting guide tunnel 116A, 116B, 1160, 116D, 116E etc.as illustrated in FIG. 5. As targeting guide tunnels come in differentdiameters, the scalpel instrument 10 of the present invention may comein corresponding diameters. Additionally, it is preferable that thebarrel 40 of the present invention scalpel be shaped as a circularcylinder, but may also be of any shape, such as triangular, rectangular,octagonal, and so on, as long as the outer diameter D1 of the barrel 40fits snugly within the inner diameter of the targeting guide tunnel.

The scalpel instrument 10 also has two blades 20, 30. While the scalpelinstrument 10 may have any number of blades, the preferred embodiment isshown with two blades 20 and 30. In the default position, the two blades20 and 30 lay one atop the other with their cutting edges facing thecenterline, as best illustrated in FIGS. 3 and 4A.

The blades 20 and 30 are expanded and retracted by a retraction means50. The retraction means 50 may be of any form, but are here shown as aspring-loaded plunger 52 with a finger hold 70 and 72 located near theproximal end 64 of a plunger rod 60 and may or may not have a transverserod 66 located at the tip of the distal end 62. The preferred embodimentutilizes a transverse rod 66, but the objectives of the presentinvention may be fulfilled by other means such as just the distal tip ofthe plunger rod 60. If the retraction means 50 is of a spring-loadedplunger 52, the spring 54 may be located anywhere on the apparatus as isuseful and required to perform the objectives of the present invention.The two blades 20 and 30 have matching slots 22 and 32 respectively thatare identical to each other when the blades 20 and 30 are placed flatone over the other facing the same direction, and are also at an angleto the direction of the plunger rod 60, as shown in FIG. 2 and FIG. 3B.When the blades 20 and 30 are installed, the blades 20 and 30 are facingopposite directions, and therefore, the base of the two slots 22 and 32are aligned, but the angles of the slots 22 and 32 are now going inopposite directions, as shown in FIGS. 3 and 3B. The transverse rod 66is engaged in the matching slots 22 and 32 of the respective blades 20and 30. The default position for the spring-loaded plunger 52 is in theretracted concave V-shape position, as shown in FIG. 2 and detailed inFIGS. 3 and 3B. This corresponds to the fully open position of thescissor blades, 20 and 30. Placing two fingers, such as the first fingerand second finger of a hand, into the finger holds 70 and 72, the thumbis available to depress the cover 56 of spring-loaded plunger 52. Thethumb depresses the cover 56 and thereby depresses the spring-loadedplunger 52, causing the spring 54 to compress and the plunger rod 60 tomove forward up the barrel 40 of the shaft towards the distal end 42 ofthe barrel 40. As the plunger rod 60 moves forward, the transverse rod66 advances along the matching slots 22 and 32 until it reaches the ends24 and 34 of the slots 22 and 32. The transverse rod 66 has pushed bothblades 20 and 30 simultaneously upward and because of the slots 22 and32 of each blade 20 and 30 being oriented in opposite directions, theproximal ends of the two blades 20 and 30 angle outwardly and cross overeach other as illustrated in FIG. 3C, so that the proximal ends of theblades expand beyond the confines of the handle, while the pointed tipsof the distal ends of the blades 20 and 30 move in correspondingopposite directions, and come together as a single, sharp point in aconvex V-shape formation cutting surface of the present inventionscalpel, as detailed in FIGS. 3A and 4, and shown in FIG. 1. The cuttingedges are thus in the shape of a sharp-pointed, two-edged scalpel. Aportion of the blades 20 and 30 resides within the barrel 40 of thescalpel instrument 10 at the distal end 42 of the barrel 40.

The fully expanded position of the proximal ends of the bladessimultaneously represents the fully closed position of the scissors endsof the blades as seen in FIGS. 3A and 4. The retraction, partial orfull, involves the partial or full release of the retraction mechanism,which in the preferred embodiment entails the release of thespring-loaded plunger 52, wherein the plunger rod 60 withdraws down thelength L1 of the barrel 40, and the transverse rod 66 willcorrespondingly withdraw down the matching slots 22 and 32 to engage thealigned ends 26 and 36 of the matching slots 22 and 32 of the blades 20and 30 causing the blades 20 and 30 to radially retract one over theother and further to withdraw down the barrel 40 of the scalpelinstrument 10. It should be noted that when the blades 20 and 30 are infull retraction position, the blades 20 and 30 are in concave V-shape oropen-scissors formation, as detailed in FIGS. 3 and 4A. The barrel 40 ofthe scalpel instrument 10 is long enough to reach the bone in thisposition.

When the cutting edge of the targeted scalpel forms a sharp pointedconvex V-shape, as illustrated in FIGS. 3A and 4, if the scalpel isinserted straight down to the bone through the targeting guide tunnel,and then withdrawn straight out, without any sideways movements, theterminal end of the path made in this manner will be a triangular shapedspace that will have the triangular dimensions of the triangular cuttingedge, and the deepest part of the path created by the cutting edge willbe a point. This will be of little consequence if the present inventionscalpel instrument traverses only soft-tissues such as fat and muscle,since the drill guide can easily be advanced to the bone through suchsoft-tissue, and the objectives of the present invention will beachieved. However, the fascia lata and the iliotibial band lie againstthe bone and therefore, as soon as the advancing tip of the bladepenetrates the deep fascia it will come up against the bone, and will beprevented from further advancement, and from making an adequate incisionin the deep fascia, having made only a small puncture hole.

Although the drill guide has a conical leading end, FIG. 14E, it willnot pass through a small puncture hole. The surgeon may safely, easilyand quickly overcome the thick deep fascia in the most precise andefficient manner by placing the mobile, two-bladed present inventionscalpel instrument in a second cutting position, FIG. 4A. The presentinvention scalpel instrument may have two blade positions, such that inthe first blade position it is configured in a convex V-shape, sharppointed, double-edged cutting surface with a single point as the leadingedge, as shown in FIG. 3A and FIG. 4. A second blade position has twoadvancing points, which together form the shape of a concave V-shape, asillustrated in FIG. 3 and FIG. 4A. Additionally the cutting edges of theblades face toward the centerline when they are in the concave V-shapeposition. In moving from the concave V-shape to the convex V-shapeposition, the blades cross over each other so that the cutting edgesface away from the centerline in the convex V-shape position. As theblades move from the concave V-shape to the convex V-shape position andback again, activated by the surgeon through the spring-loaded plunger,they function as a surgical scissors as seen in FIGS. 4A, 3C and 4.

The surgeon will advance the blade the full distance from the skin tothe bone in the first blade position as a convex V-shape until thepresent invention scalpel instrument's sharp tip touches bone. Thepresent invention scalpel instrument is then withdrawn about one halfinch, then is changed to the second blade position, the concave V-shapeposition, or open-scissors position, and again advanced towards the boneuntil the two sharp points of the concave V-shape penetrate the deepfascia. The surgeon then depresses the spring-loaded plunger causing thetwo center-facing cutting edges to move towards each other as surgicalscissors, or as two independent slicing instruments, which now completean incision between the two puncture points. Even then, as discussedbefore, this single incision will not be wide enough to allow passage ofthe cylindrical drill guide, because the single incision will only be aswide as the external diameter of the drill guide and in non-elastictissue the incision needs to be 57% larger than the diameter of thedrill guide. Therefore the present invention scalpel instrument, stillin the second blade position, concave V-shape configuration, is againwithdrawn about one half inch, rotated ninety degrees and again advancedto the bone until the two sharp points again penetrate the deep fascia.Using the scissors-function, a second fascial incision is made at 90degrees to the first incision, thus creating a cruciate incision. Thetwo arms of the cruciate incision are each only as long as the externaldiameter of the drill guide, but in the cruciate configuration, the twotogether create a larger opening in the fascia. In the inelastic fasciasuch a cruciate incision will still not allow passage of the full drillguide. Fortunately the drill guide has a conical nose, which will easilypass through this smaller cruciate fascial incision.

The present invention method and the present invention scalpel apparatusnow have made it fairly easy to advance the bullet-nosed drill guidethrough this minimal cruciate opening in the deep fascia as seen inFIGS. 14E and 14F. The cruciate incision in the deep fascia, with eachof its two arms equal in length to the diameter of the drill guide istherefore the smallest incision possible to accommodate the instruments.

The scalpel instrument described here is unique in that it is twoinstruments in one: a surgical scissors and a double-edged, sharppointed surgical scalpel. In the fully retracted position as seen inFIG. 4A, the blades are an open-scissors with the sharp blade-edgesfacing the centerline. Moving from the retracted position FIG. 4A to thedeployed position, FIG. 3A the sharp edges of the two blades move towardeach other in a scissoring action. The blades cross over each other,FIG. 3C, so that in the fully deployed blade position, FIG. 3A, the twocutting edges face away from the centerline, forming a sharp pointedscalpel, with sharp, side-cutting edges, functioning usefully topuncture the skin, and make an incision as wide as the deployed cuttingsurface. As the blades move from the contracted to the deployed positionand back again with the cutting surfaces facing each other, theyusefully function as a surgical scissors. The deep fascia is firstpierced by a forward thrusting motion of the two sharp pointed blades inthe concave V-shape position or open-scissors position, seen in FIG. 4A,and the first “arm” of the cruciate incision is then completed by thescissoring action of the blades by the two cutting edges moving towardseach other. The present invention scalpel instrument is partiallywithdrawn, rotated 90 degrees, again advanced toward the bone, the twosharp points again penetrate the deep fascia, and the second “arm” iscompleted by a scissoring action, thus completing the cruciate cut.

The advantages of the present invention method and apparatus arenumerous. By making an incision through the skin and soft-tissues withthe present invention method and scalpel instrument, the surgeon makes aminimal incision quickly and accurately. The skin incision andsoft-tissue path will be precisely the correct width needed for passageof the drill guide and other instruments, the incision through the deepfascia will be slightly smaller but adequate for the passage of thebullet-nosed drill guide, damage to the fascia lata, iliotibial band andother soft-tissues will be minimized, bleeding will be decreased, thetime to make the incision will be shorter, the time taken to close eachwound will be shorter, the time under anesthesia will be shortened, andthe resulting scar will be more cosmetic.

The surgical scalpel of the present invention is tunnel guided throughhuman or animal skin and soft tissues to its destination at the surfaceof any underlying bone. This requires an adequate cutting surface thatis thrust forward along the path of the knife. It is preferable for thesoft-tissue tunnel to have the same width all along its length, from theskin incision to the bone. The present invention scalpel in the convexV-shape configuration creates such a tunnel from the skin to the fascia.However, the sharp-pointed blade only makes a puncture hole in the deepfascia. Then, by a scissor cutting method, a cruciate incision is madein the deep fascia that is smaller than the soft tissue tunnel, butsufficient for passage of the bullet nose of the drill guide.

It is a well-known fact that the slightest contact of a scalpel'scutting edge against any metal surface will immediately dull thesharpness of the cutting edge. If a scalpel is used that has anadvancing edge in a V-configuration, that is with its blades facing awayfrom the center line of the blade, in passing the tunnel guided knifethrough a metal tunnel guide there is great likelihood that some or allof the cutting surfaces will touch the sides of the metal targetingtunnel guide at least some point along its excursion, especially as theknife edge is being introduced into the opening of the targeting guidetunnel. The sharp cutting edges of a knife in the concave V-shape whereonly the inner edges of the concave V-shape are sharp and the outeredges are dull will therefore be protected from any such metal-to-metalcontact.

Additionally, since the sharp cutting edges of each of the multi-bladeembodiments of the present invention face inwards, and the dull outeredges outward, there is less likelihood that operating room personnelwill cut themselves on the blades. Additionally, since all the cuttingsurfaces face inwardly in the concave V-shape position, the cuttingsurfaces described here will only cut on forward thrusting, or onscissoring. Therefore the skin cannot be additionally, accidentally, cuton withdrawal of the instrument, even if this instrument is unintendedlyrotated upon withdrawal.

Referring now to the FIGS. 5 through 17, there is shown the method 400and apparatus 10 for making a precise and minimal skin and soft-tissuetunnel, and a minimal cruciate incision in the deep fascia. In FIGS. 5,6 and 7 there is shown an outrigger 110 to which a locking nail 130 isattached at a first end 112 of the outrigger 110 and a targeting device114 is attached at a second end 118 of the outrigger 110. A locking nail130 is inserted into the bone 200, usually through the base 210 of thebone 200. The locking nail 130 has multiple screw holes 132A, 132B,132C, 132D, 132E, etc. through which a screw 140, see FIG. 16, will beaffixed, however once the locking nail 130 is inserted into the bone200, the screw holes 132A, 132B, 132C, 132D, 132E cannot be seen. Thetargeting guide 114 has numerous holes, the targeting guide tunnels,116A, 116B, 116C, 116D 116E, etc. that align with the screw holes 132A,132B, 132C, 132D, 132E, etc of the locking nail 130. The locking nail130 and the targeting guide 114 are each removably affixed to theoutrigger 110, which, among other things, maintains the alignment of thescrew holes 132A, 132B, 132C, 132D, 132E, etc. of the locking nail 130and the corresponding targeting guide tunnels 116A. 116B, 116C, 116D,116E, etc. of the targeting guide 114. Once it has been determined whichscrew hole 132A, 132B, 132C, 132D, 132E of the locking nail 130 shouldbe engaged with a screw 140, a targeting guide tunnel 116 is selectedfrom hole 116A, 116B, 116C, 116D, 116E, etc. which corresponds to arespective hole 132A, 132B, 132C, 132D and 132E in the locking nail 130.For purposes of illustration only, the targeting guide tunnel 116B isnow in position exactly where the screw hole 132B of the locking nail130 is located at the exact angle at which the screw 140 will beinserted and affixed to the locking nail 114, and is now in position forthe present invention scalpel 10 to create a soft-tissue tunnel 230,followed by insertion of the screw 140, and surgical closing procedures.

FIG. 7 is a partial cross-section of a bone 200 covered with skin andsoft tissue 240 with the locking nail 130 inserted into the bone 200 anda perspective view of the aligned targeting guide 114 in place with thepresent invention scalpel instrument 10 inserted through a targetingguide tunnel 116B in the targeting guide 114 and the blades 20 and 30moved out of the scalpel 10 and about to enter the skin 240 with aconvex V-shape point for the scalpel blades 20 and 30.

FIGS. 8 and 9 are examples of prior art and limitations thereof whenmaking an incision and soft-tissue tunnel. It can be seen that currentmethods of creating an incision and a soft-tissue tunnel, are performedcrudely and unguidedly. The surgeon must present the scalpel to the skinat an angle because the scalpel cannot be brought perpendicular to thespot because the targeting device 114, previously shown, is in the way.The surgeon must work around the targeting device 114, which thereforemeans that the scalpel is presented at an angle that is not 90 degreesto the bone. It can be seen that an incision from this angle through theskin and soft-tissue to the bone, creates an initial incision that isnot where a screw 140 will be presented for entrance and is not of therequired size. Nor does it create a soft-tissue tunnel that follows thesame path that the screw 140 will travel to the bone. Additionally, itcan further be seen that the soft-tissue tunnel ends in a single pointat the bone. Under current practice, in order to create a skin incisionthat is located where the screw 140 will be presented, the surgeon mustwiggle the scalpel back and forth, in a free-hand manner, to create theinitial incision. Additionally, the surgeon must continue to wiggle thescalpel back and forth as it passes through the soft-tissue, so as tocreate a soft-tissue tunnel that will allow the screw 140 to progressperpendicularly to the fascia, and further, once the scalpel has reachedthe fascia, the surgeon continues to wiggle the scalpel back and forth,slicing the fascia and scraping against the bone, so as to cut a anoversized, straight line path between the targeting guide tunnel and thepoint of screw insertion on the bone surface. All of this is performedfree hand, without guidance, and with the surgeon guessing theapproximate locations of where the scalpel blade is as compared to thetunnel that must be made. It can be seen that quite a bit of skin andsoft-tissue is cut, far more than is necessary, to make an incision andsoft-tissue tunnel for a screw 140. Usually the surgeon makes a long,longitudinal incision in the deep fascia. If a cruciate incision is madethe damage is doubled, as the surgeon performs the above procedure,partly withdraws the scalpel and performs the same procedure blind,entering the previous incision at an angle approximately ninety degreesto the first incision. It can be seen that the prior art is impreciseand creates a greater amount of damage to the patient than what issurgically necessary.

FIG. 10 is an illustration of the next step after FIG. 7 wherein thereis illustrated a cross-sectional view of the preferred embodiment of thepresent invention scalpel instrument 10 in use in the continuing method400 of the present invention, wherein the blades 20 and 30 of thescalpel instrument 10 are in theme convex V-shape formation and haveadvanced through the skin and soft-tissue 240 and reached the bone 200.It can be seen that the skin incision and the soft-tissue tunnel 230that is created by the present invention is wider than the handle barrel40 of the scalpel instrument 10, and is at an angle that is the exactpath that the screw 140 will follow. It can be seen that the sharpconvex V-shape tip of the cutting surface made by two blades 20 and 30has penetrated the deep fascia 801, has come to rest against the bone200, through a small puncture hole, and is prevented from furtherpenetration through the deep fascia 801, by the bone 200, leaving aninsufficient pathway through the deep fascia 801 for the bullet-nosedend of the drill guide 802, to pass through.

FIG. 11 is an illustration of the next step after FIG. 10 wherein thereis illustrated a cross-sectional view of the preferred embodiment of thepresent invention scalpel instrument 10 in use in the continuing method400 of the present invention, wherein the blades 20 and 30 of thescalpel instrument 10 are in the convex V-shape formation, have reachedthe bone 200, and are now being withdrawn. It can be seen that at thispoint the soft-tissue tunnel 230 ends in a convex V-shape formation,matching the shape of the blades 20 and 30 of the scalpel 10, leaving aninsufficient opening in the deep fascia 801, for passage of thebullet-nosed tip of the drill guide 802, to pass through. It is desirousthat the soft-tissue tunnel 230 does not end with a point at the bone200. It will be seen that the next steps in the present invention method400 will create a complete tunnel 230 that will have access to the bone200, and terminates in the cruciate incision in the deep fascia, and notmerely the single point where the two blades 20 and 30 meet the bone200, as created in this step of the method 400 so far.

FIG. 12 is a partial cross-section of a bone 200 covered with skin andsoft-tissue 240 with the locking nail 130 inserted into the bone 200 anda perspective view of the aligned targeting guide 114 in place with thepresent invention scalpel instrument 10 inserted through a targetingguide tunnel and the blades 20 and 30 moved into the concave V-shape oropen-scissors configuration; also illustrating that the soft-tissuetunnel 230 is, at this step in the method 400, a convex V-shape incision242 that has been made in the skin and soft tissues 240, and deep fascia801, from the previous steps.

FIG. 13 is a detail illustration of the next step in the method 400after FIG. 12, wherein there is illustrated a cross-sectional view ofthe preferred embodiment of the present invention scalpel instrument 10in use in the method 400 of the present invention wherein the blades 20and 30 of the scalpel instrument 10 are in the concave V-shape orscissors formation and have traversed the path of the previously madesoft-tissue tunnel 230, the sharp tips of the blades 20 and 30 havepenetrated the deep fascia 801, reached the bone 200 and, using thescissors action of the blades 20 and 30, are about to make a firstincision in the deep fascia 801.

FIG. 14 is an illustration of the next step in the method 400 after FIG.13, wherein there is illustrated a cross-sectional view of the preferredembodiment of the present invention scalpel instrument 10 in use in themethod 400 of the present invention, wherein the scalpel instrument 10is in the concave V-shape or open-scissors formation, had previouslyreached the bone 200; had previously made a scissoring incision in thedeep fascia 801, and is now being withdrawn. It can now be seen that thesoft-tissue tunnel 230 does not end in a convex V-shape incision 242,which was created previously, but now ends in a straight-line incision243, the scalpel instrument 10 was then partly withdrawn and rotated 90degrees and advanced toward the bone 200, so that the sharp tips of theblades 20 and 30 of the present invention scalpel 10 have againpenetrated the deep fascia creating a second incision in the deep fasciaintersecting the first incision at 90 degrees thus creating a cruciateincision 803, through the deep fascia 801, which is slightly smallerthan the soft tissue tunnel 230 but which will sufficiently allowpassage of the bullet-nosed end of the drill guide 803, to the surfaceof the bone 200 as seen in FIG. 14E an 14F, thereby allowing full accessto the bone 200, and the future placement of a screw 140, unimpeded andwithout further damage to the soft tissue 240.

FIG. 14A is a detail illustration of the first step in making a cruciateincision in the deep fascia; the two blades of present invention scalpelinstrument have punctured the deep fascia in the concave V-shapeposition.

FIG. 14B is a detail illustration of the incision in the deep fasciaafter the present invention scalpel instrument has punctured the deepfascia in the concave V-shape position and the two blades have movedtoward each other in a scissors-action and have completed the first armof the cruciate incision in the deep fascia.

FIG. 14C is a detail illustration of the cruciate incision in the deepfascia after the present invention scalpel instrument has punctured thedeep fascia in the concave V-shape position and by scissors-action hascompleted one arm of the cruciate incision in the deep fascia; thescalpel instrument was then partly withdrawn and rotated 90 degrees andthen advanced toward the bone to penetrate the deep fascia a second timein the concave V-shape position.

FIG. 14D is a detail illustration of the next step in the method 400,illustrating the preferred embodiment of the present invention scalpelinstrument being withdrawn from the cruciate incision 803, aftercompleting the second arm of the cruciate incision by a scissors action.thus making a small cruciate incision in the deep fascia with two equalarms, the length of each arm equal to the diameter of the barrel of thescalpel device, the cruciate incision smaller than the soft tissuetunnel 242, but large enough to allow passage of the bullet-nosedleading end of the drill guide 802 to pass through the deep fascia anddown to the surface of the bone as seen in FIGS. 14E and 14F, therebyallowing full access to the bone 200 and the future placement of a screw140 unimpeded and without further damage to the soft-tissue 240.

FIG. 14E is the next step in the method 400, illustrating thebullet-nosed drill guide 802 having passed through the targeting guidetunnel 116B, having passed through the soft tissue tunnel in the skinand soft tissues 230, and is about to pass through the cruciate incision803, in the deep fascia.

FIG. 14F is the next step in the method 400, illustrating thebullet-nosed drill guide 802 has passed through the cruciate incision803, in the deep fascia and is against the bone 200, in readiness forthe drill to pass through the drill guide 802, and drill a hole throughthe bone 200 for placement of a screw 140, into the bone 200.

FIG. 15 is the next step in the method 400, illustrating a partialcross-section of a bone 200 covered with skin and soft-tissue 240 withthe locking nail 130 inserted into the bone 200 and a perspective viewof the aligned targeting guide 114 in place with the present inventionscalpel instrument 10 inserted through a targeting guide tunnel 116B inthe targeting guide 114 the blades 20 and 30, in concave V-shaperetracted formation, removed from the skin and soft-tissue 240, therebycreating a soft-tissue tunnel 230 that ends in a straight-line incision243 at the bone 200. It can be seen that the soft-tissue tunnel 230 madeby the present invention method 400 and apparatus 10, is in exactalignment with the screw hole 132B and the targeting guide tunnel 116B.It can further be seen that the straight-line incision 243 of thesoft-tissue tunnel has been made with minimal trauma and minimal damageto the soft-tissue and deep fascia 240. It can further be seen that thesoft-tissue tunnel 230 has not been made free hand, or by chance, butwas carefully and precisely guided by the present invention method 400using the present invention scalpel 10. It can further be seen that thepresent invention method 400 and apparatus 10 creates a soft-tissuetunnel 230 far more quickly, and yet still exceedingly precisely, thanprior art methods and scalpels.

FIG. 16 is the next step in the method 400, illustrating a partialcross-section of a bone 200 covered with skin and soft-tissue 240 withthe locking nail 130 inserted into the bone 200 and a perspective viewof the aligned targeting guide 114 in place with the screw guide sleeve220, in the targeting guide tunnel 116B. The scalpel 10 of the presentinvention has been removed from the targeting tunnel 116B and the method400 of the present invention continues by inserting the screw guidesleeve 220 into the skin and soft-tissue tunnel 230 that ends at thebone. When the screw guide sleeve 220 reaches the bone 200, a screw 140is guided through the screw guide sleeve 220 and surgically insertedwith a screw driver 804 through the bone 200 and through a screw hole132B in the locking nail 130, which corresponds with targeting guidetunnel 116B.

FIG. 17 is the next step in the method 400, illustrating the bone 200after the use of the method 400 and apparatus 10 of the presentinvention has been utilized. It can be seen that the locking nail 130remains in place in the bone 200 and that two screws 140A, 140B, havebeen properly and precisely affixed at the correct angles to the bone200.

Described even more broadly, the present invention is a scalpel,comprising: (a) one mobile blade configured in such a way that itsnarrowest dimension is the same as, or narrower than, the width of ascalpel barrel, while the widest dimension of the blade is sufficientlywider than the width of the barrel to make an incision in skin; (b) theblade is set in such a way that it does not protrude radially outsidethe profile of the scalpel barrel in the contracted position; and (c)the blade is designed to create an incision of a given width byprotruding beyond the radius of the barrel by a mechanism that rotatesthe blade 90 degrees so that by rotating the blade 90 degrees afterpassage through a targeting guide tunnel, a wider dimension protrudesradially from the sides of the barrel, and thereby presents a cuttingedge that is wider than the scalpel barrel.

Of course the present invention is not intended to be restricted to anyparticular form or arrangement, or any specific embodiment, or anyspecific use, disclosed herein, since the same may be modified invarious particulars or relations without departing from the spirit orscope of the claimed invention herein above shown and described of whichthe apparatus or method shown is intended only for illustration anddisclosure of an operative embodiment and not to show all of the variousforms or modifications in which this invention might be embodied oroperated.

What is claimed is:
 1. A surgical tool comprising: a. an elongatedhousing with first and second ends, a first blade with a first cuttingedge, a second blade with a second cutting edge, each of the bladesbeing movably connected to the first end of the housing, an actuationmechanism movably connected to the second end of the housing and is instructural communication with each of the blades, wherein movement ofthe actuation member moves the blades between a rest scissors positionand a scalpel position, when the blades are in the rest scissorsposition, a portion of each of the first and second cutting edges areinwardly spaced to define a gap and the movement from the rest scissorsposition to the scalpel position allows the cutting edges to cooperateand perform scissors cutting on a work piece located in the gap, andwhen the blades are in the scalpel position the cuttings edges cooperateand form a single outer scalpel cutting edge.
 2. The surgical cuttingtool in accordance with claim 1, the gap defined by the portions of eachof the first and second cutting edges when in the rest scissors positionhas a concave V-shape.
 3. The surgical cutting tool in accordance withclaim 1, the single outer scalpel cutting edge has a convex V-shape. 4.The surgical tool in accordance with claim 1, further comprising: a. theactuation mechanism includes a spring-loaded plunger within theelongated housing, the spring-loaded plunger having a spring force whichurges the first blade and the second blade to the rest position; b.whereby, when a pushing force is exerted on the plunger to overcome thespring force of the spring-loaded plunger, the first blade and thesecond blade move from the rest scissors position to the scalpelposition.